Health Care Fraud

What is Health Care Fraud?

Health care fraud is commonly known as medical insurance billing fraud. Since health care procedures such as doctor visits, surgeries, or lab tests are usually paid by insurance companies, there is a lot of opportunity for health care fraud. Generally, health care fraud is committed by medical professionals like doctors, nurse practitioners, and therapists. It’s also common for other people working in medical offices or hospitals to commit this crime as well. Ways that this crime can be committed include:

Billing for medical services that a patient never received.

Billing patient services at a higher price than it actually costs.

Sending a duplicate claim for the same procedure.

Penalties for Health Care Fraud

The penalties for this crime depend on how much money was fraudulently claimed. When the claims are a total of $950 or less, it is tried as a misdemeanor. When charged as a misdemeanor the penalties include:

A fine up to $1,000, and/or

Up to six months in a county jail.

When the claims are more than $950, the crime becomes a wobbler, meaning it can be charged as a misdemeanor or a felony. When it is charged as a misdemeanor the penalties include:

Up to one year in a county jail, and/or

A fine up to $10,000.

When charged as a felony the penalties include:

Felony probation and up to one year in a county jail, and/or

Two, three, or five years in a county jail.

You may also face an additionally fine of $50,000 or double the amount of the fraud, whichever is greater. If a medical professional is charged with this crime, they may have their professional license revoked.

Legal Defenses for Health Care Fraud

There was a lack of knowledge or mistaken fact.

You can’t be convicted of this crime if you didn’t know that you were sending in a fraudulent or duplicated claim. Since the process of medical billing is so complicated, it’s easy for people to make mistakes without realizing.

There was no intent.

If there was no intent to commit the crime, then you can’t be charged with it. An experienced criminal defense lawyer can help find the truth.